RecycleGuard®
Auto Dismantlers Supplemental Questionnaire
Package, Auto and Umbrella
Named Insured
Owner(s) names and percentage of
ownership for each
Operations of Entity
Effective Date:
Expiration Date:
FEIN (please include all):
Company Website:
Are you an ISRI Member?
yes
no
Are you ISO certified?
yes
no
yes
no If yes, please provide details)
Has the applicant at any time filed for Chapter 7 or Chapter 11 bankruptcy?
Operations:
Please provide a photo or brochure of facility (Mandatory)
Description of operations (indicate percentage of total sales:
Used Auto parts:
Auto Body work:
New Auto parts:
Used Car Sales (If so, please also complete used car sales section):
Installation or mechanical repair:
Towing for others:
Engine or transmission rebuilding:
Other (please describe):
If there are repairs, are they only performed by an ASE certified technician?
yes
no
Do you allow public access to your facility?
yes
no
“You-pull-it” operations:
yes
no
If yes to either of the above questions, please describe the controls in place:
Are you an ARA Certified Automotive Recycler (C.A.R.)?
yes
no
Do you follow R2 standards?
yes
no
Average model year of vehicles dismantled?
How are parts sold? Show breakdown of sales via percentages (total 100%):
Showroom:
Drop Shipped:
Brokerage only:
Other (describe along with percentage):
Are there any other operations other than auto dismantling?
yes
no
If so, please describe in detail, what the operations are and provide the revenue and payroll for each:
Please provide the breakout of revenues from dismantling and the other operations (if appl):
Do you crush cars or is it contracted out?
If sub-contracted out, is there a contract in place requiring that the sub-contractor carries limits equal to or greater than you and names you as an Additional
Insured on their policy?
yes
no
(Please provide a copy of the contract.)
Do you obtain Certificates of Insurance confirming the above?
yes
no
Does the contract agree to indemnify you in the event of a loss?
yes
no
What are the projected annual sub-contracting costs for the upcoming year?
Used Auto Sales (please complete if applicable):
Please attach a copy of the bill of sale and warranty (Mandatory)
Number of used cars sold per year:
What percentage of used cars are sold “as is”?
What percentage of used cars are “rebuilds”?
What are the percentage of other types of sales?
If other types of sales, please describe:
Who are used cars sold to (i.e.: general public, used car dealers, friends, family, employees, etc…)?
Are cars sold on an “as is” basis?
yes
no
Are warranties provided?
yes
no
Number of dealer plates:
yes
no
RecycleGuard®
Auto Dismantlers Supplemental Questionnaire
Package, Auto and Umbrella
U-Pull It Operations (please complete if applicable):
Please attach a copy of the liability waiver (Mandatory)
Percentage of revenue of the total for these operations:
Are vehicles stacked?
yes
no
If stacked, how high?
Are vehicles on stands or rims?
Is there undercarriage access allowed?
yes
no
Do you charge a fee to enter the U-pull it area?
yes
no
Do you require a liability waiver to be signed by the customer?
yes
no How long do you store the signed copy?
Do you provide a copy of the waiver to the customer?
yes
no
What is your minimum age for entering this area?
Do you allow children in this area?
yes
no
Do you allow pets in this area?
yes
no
Do you have footwear restrictions in this area?
yes
no
If so, please describe:
Are safety rules posted prominently for customers to see?
Yes
no
Do you post statements banning alcohol and weapons on site?
yes
no
yes
no
If yes, please describe the area (size, fenced, lighted, cameras,
Is the u-pull it parts/yard restricted to a specific area in the yard?
etc..):
If yes, please describe the housekeeping ( how are the autos stored, ground surface, etc..):
Are the customer supervised while removing parts from vehicles?
yes
no If yes, how?
Are customers allowed to use hand-operated jacks, torches/welders, compressors or power tools?
yes
no
Do you provide hand tools to customers?
yes
no
If so, what types of tools?
Is there an area where vehicles may be lifted so that large parts, such as engines and brake systems, can be removed safely?
yes
no
Is this work above done by the insured or customer?
Do you allow the customer to work on their own vehicle on site? (I.e.: after customer pulls part, they install into their own vehicle)
yes
no
Are “Employees Only” signs posted prominently in areas where visitors are prohibited?
yes
no
Are visitors restricted from walking about the insured’s yard or entering unless accompanied by an employee?
yes
no
Are there are “No Trespassing” signs displayed on all the perimeter fencing?
yes
no
What is the average number of visitors to the premises daily?
What is the maximum number of visitors to the premises daily?
Prepared by:
Signature:
Title:
Date:
_____________________
Willis Programs
One New Hampshire Avenue, Suite 200
Portsmouth, NH 03801
Phone: 603 334-3000
RecycleGuard Submissions: [email protected]